Albertine Donker

General Discussion 323 9 A novel and promising approach regarding the treatment of disorders associated with overexpression of hepcidin such as anemia of inflammation (AI) 116 and IRIDA would be the application of hepcidin antagonists. 117 Clinically relevant hepcidin inhibitors currently undergo evaluation in randomized trials in adult patients with AI. 117 To the best of our knowledge, no studies addressing hepcidin inhibitors in children are underway yet. Regarding the implementation of hepcidin modulating therapies – either hepcidin antagonists for the above-mentioned indications or hepcidin agonists for diseases characterized by hepcidin underexpression due to ineffective erythropoiesis such as the thalassemia syndromes- we have certain reservations. As mentioned earlier, we found indications of a changing set point of hepcidin relative to body iron indicators during childhood. We suggest that the relatively high serum hepcidin levels we observed in young children might support the innate immune system of the infant and toddler, thereby providing a survival advantage in a critical and vulnerable period. We therefore recommend that this topic will be further explored before the eventual implementation of hepcidin suppressors in children diagnosed with IRIDA, in order to define safe target levels of serum hepcidin relative to ferritin and transferrin saturation for this age group.